Appeals Analyst

Arkansas Blue Cross and Blue Shield; Arkansas; Hybrid; USD 50,000 - 70,000; Full time

Job summary

A leading company in Arkansas is seeking an Appeals Analyst to review and respond to appeals and inquiries regarding adverse benefit determinations. The role requires a Bachelor’s degree or equivalent experience, with a focus on healthcare grievances and claims processing. The ideal candidate will possess strong decision-making skills and excellent communication abilities. This position offers the opportunity to work remotely from select states, contributing to a supportive and community-focused workplace.

Benefits

Free onsite gym

Onsite restaurants promoting healthy eating

Wellness programs

Qualifications

• In lieu of degree, five years' relevant experience will be considered.
• Minimum three years' healthcare grievances, appeals, or claims processing experience.

Responsibilities

• Analyze and respond to inquiries from members and providers.
• Monitor appeal statuses and communicate policies effectively.
• Suggest improvements to the appeals process.

Skills

Organizing work

Decision making

Dependability

Business writing

Communication skills

Workload management

Presentation skills

Education

Bachelor’s degree in a related field

Tools

Microsoft Office

Job description

Applicants must be eligible to begin work on the date of hire. Applicants must be currently authorized to work in the United States on a full-time basis. ARKANSAS BLUE CROSS BLUE SHIELD will NOT sponsor applicants for work visas in this position.

Arkansas Blue Cross is only seeking applicants for remote positions from the following states:

Arkansas, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Mississippi, Oklahoma, South Carolina, Tennessee, Texas, Virginia and Wisconsin.

Workforce Scheduling

Job Summary

The Appeals Analyst reviews and responds to appeals and inquiries from members, providers, authorized representatives, insurance departments, and/or other regulatory bodies regarding adverse benefit determinations within the timeframes set forth in both federal and state law. This position must exercise impartial judgment to determine whether an adverse benefit determination was legal, appropriate, and in accordance with the applicable contract, without favoring either the Company or the member.

Requirements

EDUCATION

Bachelor’s degree in a related field. In lieu of degree, five (5) years' relevant experience will be considered.

EXPERIENCE

Minimum three (3) years' healthcare grievances, appeals, claims processing, claims research, customer service, or related legal experience.
Working knowledge of insurance products, policies, procedures, and claims processing preferred.
Experience using Microsoft Office (Word and Excel).

Skills & Abilities

• Organizing work
• Work independently
• Decision making and sound judgment
• Dependability
• HIPAA and legal confidentiality
• Business writing and communication skills
• Initiative and medical knowledge
• Workload and time management
• Presentation skills

Excellent written and verbal communication skills; a writing sample may be requested.

Responsibilities

• Analyze and respond to inquiries, complaints, and concerns from members, providers, and regulatory bodies; prepare written analyses within required timeframes.
• Monitor appeal statuses and communicate policies and guidelines effectively to facilitate resolution.
• Maintain detailed records of all cases and appeals.
• Stay updated on benefit plans and medical coding standards (CMS, CPT, ICD-10).
• Suggest improvements to the appeals process and contract language to reduce legal and regulatory risks.

Certifications & Security

This position is classified as level three (3). It requires ensuring the confidentiality and security of records as per company policies.

Employment Type

Regular

ADA Requirements

Office-based or remote work with occasional travel within walking distance of the primary work location.

About Us

Arkansas Blue Cross is ranked as one of the best places to work in Central Arkansas.

We Love Our Employees

We offer incentives such as a free onsite gym, onsite restaurants promoting healthy eating, and wellness programs.

We Love Our Culture

Our employee tenure averages 10 years, with a culture that celebrates diversity and inclusion.

We Love Our Community

Employees volunteer and participate in community service, charity events, and disaster relief efforts, demonstrating our commitment to caring.